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Application of Arthroscopy in the Treatment of Rheumatoid Wrist

  • Clara Wong Wing Yee
  • Pak-cheong HoEmail author
Chapter

Abstract

Rheumatoid arthritis is a common autoimmune systemic inflammatory disease affecting approximately 1 % of the worldwide population (Gibofsky, Am J Manag Care 20:S128–135, 2014). Wrist joints are commonly involved. Within 2 years of diagnosis, more than half of patients will have wrist pain, and more than 90 % will have wrist disease by 10 years (Rizzo and Cooney, Hand Clin 27(1):57–72, 2011). The pain, swelling, instability, and deformity cause significant disability. Symptomatic relief of pain; improvement of function; protection of the capsular, ligamentous, and tendinous structures; and possible systemic amelioration of the disease after open synovectomy were well reported (Rombouts, Louvain Med 97:151–8, 1978; Thompson et al., Proc R Soc Med 66:197, 1973; Gschwend and Kentsch, Clin Rheumatol. 4:23–5, 1985; Brattsrom, Clin Rheumatol 4:19–22, 1985; Wilkinson and Lowry, J Bone Joint Surg Br 47(3):482–8, 1965; Lefevre et al., Nat Med 15:1414–20, 2009). Rewarding results of arthroscopic synovectomy were also demonstrated in previous studies (Adolfsson and Nylander, J Hand Surg Br 18(1):92–6, 1993; Adolfsson, Hand Clin 27(3):395–9, 2011; Adolfsson and Frisen, J Hand Surg Br 22(6):711–3, 1997; Wei et al., Arthroscopy 17(8):884–7, 2001; Park et al., J Bone Joint Surg Br 85(7):1011–5, 2003; Kim et al., Clin Orthop Relat Res 449:262–6, 2006; Lee et al., J Hand Surg Am 39(7):1295–300, 2014). With the additional advantages of minimal invasiveness and relative benignity, arthroscopic procedures are replacing open procedures. The advancement of surgical techniques and skills of operation now extend the role of arthroscopy beyond synovectomy to more complicated reconstructive surgeries in the rheumatoid wrists. The role of arthroscopy, analysis of our long-term results of 13 years (6–17.5 years), surgical techniques, and other applications of arthroscopy in patients with rheumatoid wrists are discussed here in detail. Videos are included in this chapter and can be accessed online.

Keywords

Wrist arthroscopy Synovectomy Partial wrist fusion TFCC reconstruction Hemiresection Wafer Long-term follow-up 

Supplementary material

Video 14.1

Arthroscopic view of hemiresection of ulnar head. (MOV 2799 kb)

Video 14.2

Postoperative clinical condition. (MP4 10463 kb)

Video 14.3

Intraoperative fluoroscopic screening. (MOV 3413 kb)

Video 14.4

Clinical condition 9 months after the operation. (MOV 12231 kb)

Video 14.5

Preoperative clinical condition. (MOV 4907 kb)

Video 14.6

Clinical condition at 6 months after the operation. (MOV 13605 kb)

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumatologyPrince of Wales HospitalHong KongChina

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